Patients Undergoing Cardiopulmonary Resuscitation: Candidates For Extracorporeal Life Support?

Conventionally therapy-refractory cardiac arrest usually has a fatal outcome. Extracorporeal life support (ECLS) has the potential to provide immediate full cardiopulmonary support and becomes increasingly implemented in the setting of cardiopulmonary resuscitation (Extracorporeal Cardiopulmonary Resuscitation, ECPR).This article aims to provide insights into current study results and a synopsis of the technique of ECPR.This article gives a systematic overview of available data and recommendations in combination with a focused presentation of key elements of ECPR.In the setting of unsuccessful conventional cardiopulmonary resuscitation, ECPR can be used to establish a sufficient circulation. No data from prospective, randomized controlled trials are currently available. It is a highly invasive technique that requires substantial expertise. Parameters that may assist in triaging the patients include age, comorbidities, witnessed cardiac arrest, ischemia time, quality and duration of resuscitation and use of mechanical chest compression devices. Preimplantation pH and lactate levels provide valuable additional information on the metabolic status and perfusion during resuscitation.The use of ECPR should be limited to centers of maximum care providing the full spectrum of modern interdisciplinary cardiac medicine, including ventricular assist device implantation and thoracic organ transplantation. Randomized controlled trials and comprehensive guidelines are urgently needed. The definition of minimum case numbers and the establishment of competence centers need to be discussed.